Nordic Hamstring Exercises

Nordic Hamstring Exercises in Physiotherapy and Rehabilitation

Hamstring injuries are among the most common issues faced in sports and physical activity. Often recurring, and interfering with return to play. In physiotherapy rehabilitation, targeting eccentric strength and muscle architecture is a key strategy. And one exercise that has increasingly strong evidence are Nordic Hamstring Exercises. Sometimes called the Nordic Hamstring Curl or Nordic Drop.

What Is the Nordic Hamstring Exercise?

The Nordic hamstring exercise is an eccentric hamstring exercise, which means that the muscle is lengthening while being loaded. This exercise begins in a kneeling position with the lower legs fixed by a partner or secure apparatus, then lowering the upper body slowly forward while resisting the descent with their hamstrings. Hands should be used to catch or assist as needed. The goal is to eccentrically load the hamstrings. Meaning they are contracting while lengthening. Gradually as strength improves, it should become easier to further lower your body without support from your hands.

Why Eccentric Hamstring Training Matters

Eccentric loading has several beneficial effects relevant to rehabilitation:

1. Increased Strength: Eccentric exercises strengthen the hamstring muscles during lengthening contractions. Which is important because many hamstring strains happen during these types of activities. Sprinting deceleration during football is a prime example of an activity that involves an eccentric Hamstring contraction.

2. Altered Muscle Architecture: Eccentric training has been shown to increase fascicle length, which is likely to reduce the risk of strains. This is because longer muscle fibres reduce the relative stretch per unit of length.

3. Improved Neuromuscular Control, Flexibility, and Functional Performance: Eccentric hamstring training also improves the flexibility, dynamic control, and agility during athletic performance.

Nordic Hamstring Exercises in Injury Prevention

A large systematic review and meta‐analysis by Al Attar et al. found that programs including Nordic hamstring exercises reduced hamstring injuries. Reducing injury risk by approximately 51% compared to usual training or warm-ups that do not include Nordic hamstring exercises.

In soccer players and other field sports, injury prevention programs comprising Nordic Hamstring Exercises showed a significantly lower injury incidence rate.

Rehabilitation & Functional Outcomes: The Research 

• A randomized controlled trial comparing 8 weeks of Nordic hamstring exercise vs dynamic hamstring stretching among male soccer players with hamstring “shortness” showed that Nordic Hamstring exercises led to improvements in balance, range of motion, agility, and muscle performance. BioMed Central
• In a more recent study, 4 weeks of eccentric Nordic Hamstring training, 3× per week, in recreationally active individuals showed that the Nordic Hamstring exercise group improved static/dynamic postural balance and hamstring strength compared to a control group. PLOS
• Another trial found that in people with acute hamstring strain, Nordic Hamstring exercises were more effective than conventional stretching and strengthening in reducing damage and improving function. Semantic Scholar+1

How to Use Nordic Hamstring Exercises in Rehabilitation

A physiotherapist will be able to conduct a thorough assessment and can provide more specific guidance based on the injury. Some of the following are typical principles to adhere to during recovery:

1. Progressive Loading: Begin conservatively in the early stages of rehab. Allow assistance with hands and only partial movement through the range. As strength, control, and pain tolerance improve then gradually reduce assistance, increase the range of motion, and increase the number of sets and reps.

2. Volume & Duration: There is evidence that 4-8 weeks of Nordic Hamstring exercises, with multiple sessions per week, is effective in producing changes. For example, a period of 3 sessions per week for 4 weeks has been shown to improve strength & balance. While longer periods yield architectural changes in the muscle. PLOS+2Napier University+2

3. Technique & Safety: Proper form is essential to this exercise. Maintain a neutral hip position and avoiding hip flexion too early. While slowly controlling the descent and avoiding jerky movements.

4. Integration With Other Exercises: Nordic Hamstring exercises are powerful, but they are most effective when they are used in combination with other rehabilitation techniques. General lower limb strengthening, flexibility work, neuromuscular control drills and sprint work depending on the desired goals. Consideration of functional and sport-specific movements as progression is important.

5. Individualisation and Monitoring: Programmes should be tailored to the individual and the injury. Based on severity, pain levels, strength baseline and previous injury history. Post-exercise response should be monitored and adjusted accordingly.

6. Return to Play Considerations: Before full return, include performance testing should be done to ensure hamstring strength, architecture, control, and symmetry are sufficient.